Across the South Piedmont Region, healthcare employers continue to grapple with widening workforce gaps—particularly in nursing and frontline care roles. Recent regional workforce analyses show that vacancies and turnover remain persistent challenges that strain hospital systems, long term care facilities, and community providers across Anson, Cabarrus, Cleveland, Gaston, Lincoln, Mecklenburg, Stanly, and Union Counties.

Although the region’s open position rates for RNs, LPNs, CNAs, and medical assistants are slightly lower than state averages, many employers, especially smaller non system organizations, report vacancy levels that closely resemble state-level shortages, including RN open position rates of up to 30% and LPN rates as high as 34% among non system employers. [workforceforhealth.org]

Retention remains an equally significant pressure point. Churn rates reached 57% for RNs and 82% for CNAs, indicating that many organizations are replacing more than half their workforce each year. A 2025 regional profile, further shows churn exceeding 100% annually for LPNs and CNAs, reinforcing how unstable staffing pipelines have become across the eight counties. [workforceforhealth.org] [e1.nmcdn.io]

On the supply side, nursing program output is improving, yet still falls short of employer demand. To meet annual hiring needs, the region must add 1,660 RNs, 310 LPNs, and 1,810 CNAs each year, but educational programs currently supply far fewer RNs and LPNs than required. Even when CNA graduation numbers exceed demand, the high turnover rates mean that many employers still struggle to maintain adequate staffing levels. [e1.nmcdn.io]

For employers, this is not just a staffing problem, it is a business problem. The estimated cost to replace a single RN is approximately $61,000, factoring in recruitment, onboarding, lost productivity, and strain on remaining staff. Multiply that across dozens or hundreds of vacancies, and the financial impact becomes staggering.

These combined dynamics, rising demand, modest educational output, and unsustainable turnover, highlight why the region is increasingly looking to structured work-based learning models, especially apprenticeships and earn-while-you-earn pathways as a strategy to stabilize the workforce. Apprenticeship models can expand entry pathways, strengthen retention through structured career development, and give employers more control over building talent pipelines that fit their specific clinical needs, while supporting individuals who might not otherwise access traditional education routes.

For healthcare employers, this can look like:

• CNA-to-LPN or MA-to-RN career ladders
• Paid clinical training combined with classroom instruction
• Tuition assistance tied to employment commitments
• Mentorship models that support new nurses through their first year of practice

Rather than competing solely for a limited pool of graduates, employers create their own pipelines, cultivating staff who are already connected to the organization and community.

These models offer a powerful retention advantage. Workers trained on site tend to demonstrate stronger loyalty, greater job readiness, and a clearer sense of career progression. For rural and underserved areas within the South Piedmont Region, they also expand access to healthcare careers for local residents, strengthening both workforce stability and community health.

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